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More than 70 percent of patients in the United States who develop liver cancer do so because they have cirrhosis of the liver.

Cirrhosis is a form of internal scarring of the liver, says George Y. Wu, MD, PhD, a professor of medicine and chief of the hepatology section at the University of Connecticut Medical Center in Farmington. “It usually occurs when the liver is damaged over an extended period of time. When liver cells are damaged and die due to chronic disease of the liver, fibrous scar tissue can be deposited in place of the missing cells," says Dr. Wu.

And normal cells can become cancer cells when they’ve been extensively damaged.

Liver Cancer: Causes of Cirrhosis

In the United States, the main causes of cirrhosis are alcohol abuse and chronic viral hepatitis.

While everyone needs a functioning liver to survive, once enough liver cells are replaced by scar tissue, cirrhosis becomes irreversible.

"Cirrhosis increases the risk of developing liver cancer by at least 40 times over the risk of an average person,” says Wu. “Of all people with cirrhosis, 3 percent will develop liver cancer every year. So, it is not surprising that 70 to 90 percent of all cases of liver cancer in the United States occur in livers that are cirrhotic.”

Liver Cancer: Cirrhosis Risk Factors

Chronic hepatitis can be caused by the hepatitis C and hepatitis B viruses. These viruses are spread by contact with infected body fluids. The best way to avoid hepatitis B and C is to avoid intravenous drug abuse and unsafe sex.

And then there’s alcohol: A good percentage of alcoholics will eventually develop cirrhosis. The amount of alcohol you need to drink to cause cirrhosis varies from person to person. If you are a woman, drinking two to three drinks a day over several years puts you at risk. For a man, three to four drinks a day puts you at risk for cirrhosis.

Another increasingly important cirrhosis risk factor is non-alcoholic fatty liver disease (NAFLD). Why? The obesity epidemic. This disease causes liver cells to be replaced with fat cells. NAFLD is common in people with poorly controlled diabetes and obesity.

Liver Cancer: Cirrhosis Signs and Symptoms

In the early stages of cirrhosis, there may not be any symptoms. But, as cirrhosis gets worse, symptoms can be caused by the liver’s failure to perform its many essential functions, and by scar tissue that decreases blood flow through the liver.

Many of the symptoms of cirrhosis are also the first symptoms of liver cancer. The most common symptoms of liver cancer and cirrhosis include:

Fatigue

Right-side abdominal pain

Loss of appetite and nausea

Weight loss

Yellow discoloration of the eyes and the skin

Fluid collection in the legs and abdomen

Increased bruising and bleeding

Decrease in mental function

Liver Cancer and Cirrhosis

It is not well understood how cirrhosis increases cancer risk, says Wu. “But it may be related to the increased opportunity for DNA changes to develop as the liver cells reproduce in response to the damage that leads to cirrhosis.”

Another factor, he continues, can be that the presence of cirrhosis “reflects a long duration of damage. The longer the duration of damage, the greater the chance that cancer-causing changes in DNA will occur."

Research shows that as liver cells are damaged and need to be rapidly replaced over and over again the chance of mutations — changes in the DNA — in the liver cell's DNA increases. As these mutations build up over time and are passed along, liver cells may eventually lose their ability to control their own growth. When cells start to grow uncontrollably, liver cancer can develop.

Although it’s possible to treat cirrhosis with a liver transplant, the best way to avoid liver cancer is to know the risk factors.

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